Amish as stool donors for FMT Donors

[nelson]

Starting this as a central thread to discuss establishing connections to the Amish to use them as donors for those based in the US. Traveling directly to them to receive FMT seems like a decent next best option to me in light of the FDA's shutdown of human microbes.

The previous discussion left off by stating they are unhealthy due to a lack of genetic diversity.

The Amish certainly have poor genetic health. E.g. previously mentioned have been special genetic mutations that predispose them to epilepsy. The concern, as suggested by the wiki, is that genetics can influence the microbiome, resulting in decreases in the composition of certain microbiota or even their extinction. The evidence in the wiki seems to be mixed. It nonetheless must be true to some extent; this is after all why microbiota from one species of animal fail to thrive in other species of animals: large genetic differences that make the animals different species. This paper discusses how most human microbiota fail to take hold in rats. The question is how relevant it is within-species. It seems like if this is a large effect within humans, then we should see less effective FMT colonization if there is too much genetic distance between donor and recipient. Has this been tested?

Despite bad genetics, the Amish have great protection against modern chronic diseases such as asthma, depression, cancer, etc. So I don't see any reason against simply finding the healthiest Amish, testing for pathogens, and getting FMT from them. Unlike most US donors, they are much more likely to have host-native strains that are extinct elsewhere. After all, this is the main selling point of FMT compared to dietary changes (wiki):

In short, diet changes the percentages of microbes already there, based on which microbes thrive most on what you're feeding them. And diet changes what metabolites are created, but generally does not change the fundamental make up of the gut microbiome. To change it fundamentally would require adding/subtracting microbes via interventions like FMT, antimicrobials, and possibly probiotics.

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It's certainly not a bad idea to look for athletes and top 0.1% demonstrated health. But consider that the reason someone is a healthy athlete might not be that they have missing host-native strains, but simply that they have a better balance of widely available strains, whether because of their diet or genetics which better control the microbiome. And frankly, it could also simply be that they have better genetics in athelicism (perhaps not even elsewhere) that compensates for a mediocre microbiome. Twin studies show a high influence of genetics on phenotype variation in the United States already.

Furthermore, this would be quite on-brand for the Amish, who are famous for their ways of getting around restrictions on selling raw milk.

Are there any people who live near the Amish here and can make contact with them? Is my reasoning above wrong?

 

[Michael Harrop]

The main issues for me would be that they live in secluded areas, so they're not easy to screen & use. And because of their health issues, and from what video coverage I've seen of them, they don't seem promising enough as donors for me to want to bother with them.

However, if someone else wanted to go through the trouble of traveling to them, putting the healthier-looking ones through detailed health questionnaires, taking pictures of their stool, etc. I'd be interested enough to help screen them by reviewing the material.

You'd have to travel there with a laptop and solar-powered charging system, and manually fill out their questionnaires after they verbally relay their answers to you (given their lack of familiarity with computers). They would have to be comfortable enough to tell you their private health details, and then be comfortable enough to hand you their stools so that you could photograph them.

That seems like a lot to ask, and a major ordeal, all for something I'm highly doubtful would pay off.

 

[SFBayFMT5]

Is photographing stools really necessary, if you can explain to them what the different stool types look like and ask them to determine which is closest to theirs? Yes you need to trust them, but so do you with other health information like disease and family history (the pathogen testing you can get an official copy, but symptoms you really can't verify).

 

[Michael Harrop]

In my experience, nearly everyone is horrible at judging stool quality, even after training them to identify the best stools, and it being in their interest to do so.

I've only come across one other person besides me who seems to be capable of it. So it's either take the photos to show me, bring that person with you (they're not interested in the Amish either, as far as I know), or use an AI trained by me.

 

[Aim for NaN]

The issue of genetics is a bit too complex in and of itself. What makes things all the more interesting is how the microbiome is certainly able to have an impact on genetics itself, that is, disabling or activating genes. An immediate example of this is lactose tolerant people becoming intolerant after taking an antibiotic. This example itself implies that there is much we don't know about genetics, especially how the microbiome impacts genetics. Though, the cases of home-made kefir reversing lactose intolerance may throw a wrench into the cog, too.

Aiming for athletes is not entirely the best approach. Intensive exercise has been shown to negatively impact the gut. That is, continuously activating fight or flight mode for long periods of time causes reduced blood flow to the gut, and this has been shown to negatively impact the gut, including the microbiome. The main criteria we can rely on is microbiome composition and stool consistency, which is something to be tested for in every individual. Granted, there is no established standard as to what constitutes a healthy microbiome composition, and given how complex the microbiome is there probably never will be, but I agree with the theory that healthy people are generally healthy in the same way, and unhealthy people are generally different in their unhealth.

Unless certain genes have been shown to have a negative impact on the gut and microbiome, I wouldn't worry so much about genetics, since the topic is too complex to be practical. I live in the south. As far as I know there are no Amish people here, which sucks, because I, too, have had interest in their microbiome. The Amish, however, can be found in the north eastern parts of the US, though have also been known to live in Ohio. A bigger issue would likely be convincing them to participate. This could easily be seen as entertaining modern forms of practice, which most are against.

 

[SFBayFMT5]

An immediate example of this is lactose tolerant people becoming intolerant after taking an antibiotic. This example itself implies that there is much we don't know about genetics, especially how the microbiome impacts genetics. Though, the cases of home-made kefir reversing lactose intolerance may throw a wrench into the cog, too.

Click to shrink...

This doesn't imply anything whatsoever about genetics, rather it implies something about bacterial utilization of lactose. Lactose intolerance occurs when there is insufficient lactase produced by the host to break down lactose, allowing bacteria to ferment the lactose and produce gas. So the most likely explanation is that the people who became lactose intolerant after antibiotics were already "lactose intolerant" in the genetic sense, but either:
1. There were other bacteria crowding out the lactose-utilizing bacteria, preventing them from reaching sufficient levels to cause symptoms, or
2. There were lactose-utilizing bacteria that did NOT produce gas, that consumed the lactose before the gas-producing bacteria could get to it.
In other words, if the lactase deficiency of the host is mild enough, there are specific species of bacteria that can compensate.

In fact, I suspect a very similar situation is going on with respect to respiratory/mitochondrial genes for a decent percentage of us (including most people on the autism spectrum who respond to FMT).